结肠镜联合腹腔镜下结直肠息肉切除

Application of colonoscopy combined with laparoscopy in patients with colorectal polyps

目的：探讨腹腔镜、结肠镜联合治疗结直肠息肉的手术方式、安全性和可行性。方法：分别采用腹腔镜辅助结肠镜下电凝切除、结肠镜辅助腹腔镜下部分肠壁切除、部分肠段切除及腹腔镜下结肠癌根治等方法,对36例结直肠息肉患者进行治疗。结果：36例均顺利完成手术,无中转开腹。5例在腹腔镜辅助下行结肠镜下息肉切除。22例行结肠镜辅助腹腔镜下部分肠壁切除,其中1例在结肠镜操作过程中发生难于控制的出血,另1例造成穿孔且息肉未完全切除,也行结肠镜辅助的腹腔镜下部分肠壁切除。22例中有18例用Endo-GIA完成。6例行腹腔镜下肠段切除,其中4例因息肉基部广,游离肠段后发现血供差;2例息肉位于直肠上段,且息肉稍大。3例行结肠癌根治术。手术时间70~240 min;手术出血量在20~150 mL;肠功能恢复时间20~48 h。所有患者术后均无肠瘘、肠腔狭窄、术后肠道大出血等并发症发生。结论：结肠镜、腹腔镜联合治疗结直肠息肉,提高了手术的安全性和彻底性,是一种值得推广的微创手术方式。

Objective： To explore the surgical procedures,safety and feasibility of laparoscopy combined with colonoscopy in patients with colorectal polyps.Methods： 36 patients with colorectal polyps were treated by laparoscopy-assisted endoscopic polypectomy,endoscopy-assisted laparoscopic local resection,endoscopy-assisted laparoscopic segment resection and laparoscopic radical resection respectively.Results： All cases were operated successfully,without conversions to open surgery.5 cases underwent laparoscopy-assisted endoscopic polypectomy.22 cases underwent endoscopy-assisted laparoscopic local resection,2 of which caused respectively by out of control bleeding and perforation during colonscopy,18 of which completed with Endo-GIA.6 cases underwent endoscopy-assisted laparoscopic segment resection,4 of which caused by large polyps with wide base and poor blood supply after cutting off mesenteric vascular,2 of which caused by the large polyps located in upper rectum.3 cases underwent laparoscopic radical resection.The mean operative time was 70～240 min,mean intraoperative blood loss was 20～150mL,mean recovery time of intestinal function was 20～48 h.No case occurred postoperative complications such as intestinal fistula,stenosis and large bleeding.Conclusion： Colonoscopy combined with laparoscopy is available to patients with colorectal polyps,and can improves operative safety and thoroughness.